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Endovascular Therapy for Acute Stroke with a Large Ischemic Region

By Currents Editor posted 05-20-2022 16:44


Endovascular Therapy for Acute Stroke with a Large Ischemic Region
New England Journal of Medicine (04/07/22) DOI: 10.1056/NEJMoa2118191
Yoshimura, Shinichi; Sakai, Nobuyuki; Hiroshi Yamagami; et al.

 Researchers conducted a randomized clinical trial in Japan involving patients with occlusion of large cerebral vessels and sizable strokes on imaging, as indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) value of 3 to 5. The multicenter, open-label study randomized patients to receive endovascular therapy with medical care or medical care only within six hours after they were last known to be well or within 24 hours if there was no early change on fluid-attenuated inversion recovery images. In both groups, alteplase (0.6 mg per kg of body weight) was used as needed. The endovascular-therapy group included 101 patients, while the medical-care group included 102 patients, with about 27% of patients in each group receiving alteplase. At 90 days, the percentage of patients with a modified Rankin scale score of 0-3 was 31.0% and 12.7%, respectively. Additionally, 31.0% of the endovascular-therapy group and 8.8% of the medical-care group saw an improvement of at least 8 points on the National Institutes of Health Stroke Scale score at 48 hours. Patients in the endovascular-therapy group also had more intracranial hemorrhages than those in the medical-care group, at a rate of 58.0% vs. 31.4%.


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